Mid-Term Results of Different Fixation Methods in Stable Intertrochanteric Fractures

Document Type : Original Article

Authors

Department of Orthopedic Surgery, Clinical Research Development Unit of Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran.

Abstract
Introduction: Intertrochanteric fractures are among the most common hip fractures, especially in the elderly population. DHS and PFNA, remain the main fixation methods for these fractures. This study compares the long-term results of these methods in fractures classified as OTA/AO A1 & A2.1.
Materials & Methods: A retrospective cohort study was conducted. 154 patients treated with DHS, PFNA, within 10 years in a teaching hospital were studied. Outcomes, such as infection, reoperation rate, and mortality were assessed based on age and sex in different subgroups.
Results & Discussion: Analysis of the 154 patients revealed no significant differences in infection rates, need for reoperation, or 5-year mortality between DHS and PFNA methods. However, women and patients older than 70 years treated with DHS showed a higher need for reoperation.
Conclusion: Except for women and individuals over 70 years old who had higher reoperation rates with DHS, no significant difference was observed between the two groups.

Keywords

Subjects

1         Jonnes, C., S. Shishir, and S. Najimudeen, Type II intertrochanteric fractures: proximal femoral nailing (PFN) versus dynamic hip screw (DHS). Archives of Bone and Joint Surgery, 2016. 4(1): 23-28. PMCID: PMC4733231
2         Veronese, N. and S. Maggi, Epidemiology and social costs of hip fracture. Injury, 2018. 49(8):1458-1460. https://doi.org/10.1016/j.injury.2018.04.015
3         Baumgaertner, M.R., S.L. Curtin, and D.M. Lindskog, Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clinical Orthopaedics and Related Research (1976-2007), 1998. 348: 87-94.
4         Kim, W.-Y., et al., Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. International orthopaedics, 2001. 25: 360-362. https://doi.org/10.1007/s002640100287
5         Sharma, A., A. Sethi, and S. Sharma, Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study. Revista brasileira de ortopedia, 2018. 53(4): 477-481. https://doi.org/10.1016/j.rboe.2017.07.008
6         Singh, D., et al., Comparative study of the management of intertrochanteric fracture femur with proximal femoral nail vs. the dynamic hipscrew with derotation screw in elderly population. Cureus, 2021. 13(11). DOI: 10.7759/cureus.19431
 
7         Li, H., et al., PFNA vs. DHS helical blade for elderly patients with osteoporotic femoral intertrochanteric fractures. European Review for Medical & Pharmacological Sciences, 2018. 22 (1 Suppl): 1-7.
8         Dai, P., et al., Proximal femoral nail anti‐rotation vs dynamic hip screws decrease the incidence of surgical site infections in patients with intertrochanteric fractures: A meta‐analysis. International Wound Journal, 2023. 20(8):3212-3220. https://doi.org/10.1111/iwj.14200
9         Zeng, X., et al., Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: a retrospective study with a minimum follow-up of 3 years. BMC Musculoskeletal Disorders, 2017. 18:1-7. https://doi.org/10.1186/s12891-017-1415-6
10      Chang, F.-C., et al., The effects of bone-substitute augmentation on treatment of osteoporotic intertrochanteric fractures. biomedical journal, 2021. 44(6): 717-726. https://doi.org/10.1016/j.bj.2020.05.013